Information
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Client / Site
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Location
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Conducted on
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Prepared by
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CV-ZH-FM010-WA
PERSONNEL CONTACTED
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1. Worker observed during field observation
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Worker's Name:
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Position
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Pre-Start & AOD
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STAR for current task
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SWMS reviewed and signed
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ATWP signed
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Online Induction completed
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Site Induction completed
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Competency (Operator licence, Qualification)
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VOC completed
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2. Worker observed during field observation
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Worker's Name:
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Position
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Pre-Start & AOD
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STAR for current task
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SWMS reviewed and signed
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ATWP signed
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Online Induction completed
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Site Induction completed
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Competency (Operator licence, Qualification)
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VOC completed
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3. Worker observed during field observation
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Worker's Name:
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Position
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Pre-Start & AOD
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STAR for current task
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SWMS reviewed and signed
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ATWP signed
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Online Induction completed
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Site Induction completed
-
Competency (Operator licence, Qualification)
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VOC completed
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4. Worker observed during field observation
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Worker's Name:
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Position
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Pre-Start & AOD
-
STAR for current task
-
SWMS reviewed and signed
-
ATWP signed
-
Online Induction completed
-
Site Induction completed
-
Competency (Operator licence, Qualification)
-
VOC completed
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5. Worker observed during field observation
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Worker's Name:
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Position
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Pre-Start & AOD
-
STAR for current task
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SWMS reviewed and signed
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ATWP signed
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Online Induction completed
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Site Induction completed
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Competency (Operator licence, Qualification)
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VOC completed
SAFE BEHAVIOURAL OBSERVATIONS & UNSAFE CONDITIONS
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1. BEHAVIOUR (Choose one)
- People
- Overhead and Underground Services
- Personal Protective Equipment
- Isolation, Energy Sources, Guarding
- Manual Handling
- Plant & Equipment
- Plant & Pedestrian Interface
- Environmental
- Work Practices
- Housekeeping
- Fall Protection
- Traffic Managment
- Other:
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Details:
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COMMENTS
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Was the risk controlled?
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undefined
- Elimination
- Substitution
- Isolation
- Engineering
- Administration
- PPE
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Action taken / Lessons Learned
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2. BEHAVIOUR (Choose one)
- People
- Overhead and Underground Services
- Personal Protective Equipment
- Isolation, Energy Sources, Guarding
- Manual Handling
- Plant & Equipment
- Plant & Pedestrian Interface
- Environmental
- Work Practices
- Housekeeping
- Fall Protection
- Traffic Managment
- Other:
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Details:
-
COMMENTS
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Was the risk controlled?
-
undefined
- Elimination
- Substitution
- Isolation
- Engineering
- Administration
- PPE
-
Action taken / Lessons Learned
-
3. BEHAVIOUR (Choose one)
- People
- Overhead and Underground Services
- Personal Protective Equipment
- Isolation, Energy Sources, Guarding
- Manual Handling
- Plant & Equipment
- Plant & Pedestrian Interface
- Environmental
- Work Practices
- Housekeeping
- Fall Protection
- Traffic Managment
- Other:
-
Details:
-
COMMENTS
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Was the risk controlled?
-
undefined
- Elimination
- Substitution
- Isolation
- Engineering
- Administration
- PPE
-
Action taken / Lessons Learned
-
4. BEHAVIOUR (Choose one)
- People
- Overhead and Underground Services
- Personal Protective Equipment
- Isolation, Energy Sources, Guarding
- Manual Handling
- Plant & Equipment
- Plant & Pedestrian Interface
- Environmental
- Work Practices
- Housekeeping
- Fall Protection
- Traffic Managment
- Other:
-
Details:
-
COMMENTS
-
Was the risk controlled?
-
undefined
- Elimination
- Substitution
- Isolation
- Engineering
- Administration
- PPE
-
Action taken / Lessons Learned
-
5. BEHAVIOUR (Choose one)
- People
- Overhead and Underground Services
- Personal Protective Equipment
- Isolation, Energy Sources, Guarding
- Manual Handling
- Plant & Equipment
- Plant & Pedestrian Interface
- Environmental
- Work Practices
- Housekeeping
- Fall Protection
- Traffic Managment
- Other:
-
Details:
-
COMMENTS
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Was the risk controlled?
-
undefined
- Elimination
- Substitution
- Isolation
- Engineering
- Administration
- PPE
-
Action taken / Lessons Learned
EQUIPMENT
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1. Equipment Type & Identification:
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Plant Risk Assessment
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Test & Tag / Maintenance in date:
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Pre-Start completed?
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2. Equipment Type & Identification:
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Plant Risk Assessment
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Test & Tag / Maintenance in date:
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Pre-Start completed?
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3. Equipment Type & Identification:
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Plant Risk Assessment
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Test & Tag / Maintenance in date:
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Pre-Start completed?
HAZARDOUS SUBSTANCE REVIEW
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1. Product Name:
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Identified Hazards of product:
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SDS available
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Product on SDS Register
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Correct PPE available & worn by Worker
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2. Product Name:
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Identified Hazards of product:
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SDS available
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Product on SDS Register
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Correct PPE available & worn by Worker
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3. Product Name:
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Identified Hazards of product:
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SDS available
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Product on SDS Register
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Correct PPE available & worn by Worker
ASSESS THE RISK
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What would a reasonably foreseeable outcome be if an incident occurred?
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Consequence
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Likelyhood
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Risk Rating
CONTROL THE RISK
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Was the risk controlled?
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undefined
- Elimination
- Substitution
- Isolation
- Engineering
- Administration
- PPE
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Action taken / Lessons Learned
OBSERVER'S DETAILS
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Name of person reporting this event:
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Enter Position
- Project Manager
- Project Superintendent
- Safety Manager
- Safety Advisor
- Engineer
- Supervisor
- Leading Hand
- Employee
- Contractor
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Enter names of personnel contacted during this activity
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Please complete section below and highlight any additional observations and actions
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Please add photo if required
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Please sketch diagram if required
APPROVAL / MANAGEMENT REVIEW
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Manager to review & approve, or send for further investigation:
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Additional actions and Learnings shared
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Management Approval:
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Distribution: (1) Project Manager (2) ZH Administrator (3) Zero Harm Advisor